Transcript Nutrition and Lower Gastrointestinal Disorders

Lower Gastrointestinal
Disorders
Common Intestinal problems
1-Constipation
Difficulty passing stools or infrequent
bowel movements; often diagnosed
when individual has fewer than 3
bowel movements/week
Other symptoms may include:
1. The passage of hard stool
2. Excessive straining during defecation.
Constipation - Causes
•
Low food intake
•
Low-fiber diets
•
Inactivity
•
Certain disorders : hypothyroidism,
diabetes mellitus, and chronic renal
disease
Neurological conditions may cause motor
problems in the intestine
•
• Higher among women especially
during pregnancy
• Increases somewhat with aging
Constipation – Causes
• Side effects of medications
dietary supplements such as :
1. aluminum-containing antacids,
2. iron and calcium supplements.
and
Constipation – Treatment
• Gradual increase in
fiber – wheat bran,
fruits ,vegetables and
fiber supplements
20-25 grams/day
High fiber diet :
1. increase stool weight
2. promote a more rapid transit of
materials through the colon
• Add prunes or prune juice to the
diet because it have mild laxative
effects
Constipation – Treatment
• Make sure that patient has sufficient
fluid intake to prevent dehydration,
which draws water from the colon to
increase hydration in the rest of the
body.
• Increasing daily exercise
Constipation – Laxatives
Laxatives work by :
1. Increasing stool weight
2. Increasing water content of the stool
3. Stimulating peristaltic contractions
2- Diarrhea
•
Diarrhea is characterized by
passage of frequent, watery stools
• In severe cases may cause dehydration
and electrolyte imbalances
• If chronic, may lead to weight loss and
malnutrition
Types and causes of diarrhea
Osmotic diarrhea :
unabsorbed nutrients attract water to the
colon and increase fecal water content
The usual causes include:
1. Lactase deficiency
2. High intake of poorly absorbed sugars like
sorbitol, manitol or fructose which retain
fluids in the colon
Secretory diarrhea :
•
Intestines are stimulated to secrete fluid
that exceeds the colon’s capacity for
reabsorption
• This type is often due to bacterial food
poisoning, intestinal inflammation
• Motility disorders :
cause diarrhea by acceleration of
entry of fluids into the colon, that
shortens the contact time needed
for fluid reabsorption
Diarrhea - Causes
• Acute diarrhea :
Lasts for less than several weeks
• Chronic diarrhea:
Lasts for a month or longer
Nutrition therapy of diarrhea
• The nutrition prescription depends on the
medical diagnosis and severity of the
condition.
 Low-residue, low-fat, lactose-free diet:
Low residue diet limits foods that contribute
to colonic residue, such as those with large
amounts of fiber, lactose, fructose.
 Avoid gas-producing foods because it can
increase intestinal distention and cause
additional discomfort
Avoid of fatty foods because it
aggravate diarrhea
Avoid coffee and tea because caffeine
stimulates GI motility and reduce
water reabsorption
Oral rehydration therapy
• Oral Rehydration therapy can
used in severe cases
be
Containing water, salts, glucose or
sucrose
Commercial
sports
drinks
are
generally not recommended because
their sodium content is too low .May
be used with salty snack
IV solutions are used in extreme
dehyderation.
Malabsorption Syndromes
Fat Malabsorption
• Fat is the nutrient most frequently
malabsorbed because both digestive
enzymes and bile must be present
for its digestion
• Thus it develops when an illness
interferes with the production
or
secretion of either bile or pancreatic
lipase
Fat Malabsorption
• It develops also as a result of cancer
radiation therapy which damage the
intestine mucosa.
• Motility disorders in the stomach of
intestine
cause fat malabsorption
because they prevent the normal
mixing of dietary fat with digestive
enzymes.
•.
• Fat Malabsorption is often evidenced
by steatorrhea
Steatorrhea:
Excessive fat in the stools resulting
from fat malabsorption;
characterized by stools that are
loose, frothy, and very bad smell due
to a high fat content
Consequences of Fat Malabsorption
Loss of:
• Energy
• Fatty acids
• Fat-soluble vitamins – A, D, E, K
• Minerals
Calcium, magnesium, zinc because
minerals form soaps with unabsorbed
fatty acids.
• Bone disease
• The risk of Kidney stones increase
The oxalates in foods ordinarily bind to
calcium in the small intestine and are
excreted in the stool.
If calcium instead binds to unabsorbed fatty
acids, oxalates are free to be absorbed into
the blood and are excreted in the urine.
The risk of developing oxalate stones
increases when urinary oxalate levels are
high.
Dietary adjustments for fat
malabsorption
• Fat restricted diet is recommended to
relive the symptoms
• Fat should not be restricted more than
necessary
• Medium-chain triglycerides which do not
require lipase or bile for digestion and
absorption may be used .It dose not
provide EFA and give 8.1 kcal/g
Lactose Intolerance
• High incidence: approximately 75%
of population worldwide
Rarely serious
Most
individuals
(with
lactose
intolerance) can tolerate milk if
consumed with other foods & limit
amount consumed at one time
Cause of lactose intolerance
• Lactose intolerance is the inability to
digest and absorb lactose (the sugar
in milk) that results from reduction
or loss of lactase, enzyme that
digests lactose in milk products
symptoms of lactose intolerance
Symptoms of lactose intolerance usually
begin 30 minutes to two hours after eating
or drinking foods that contain lactose.
Common signs and symptoms include:
• Diarrhea
• Nausea
• Abdominal cramps
• Bloating
• Gas
Symptoms are usually mild, but they may
sometimes be severe.
Dietary management of lactose
intolerance
•
In the mild cases ,gradually increased consumption of
lactose-containing products
 Divide milk intake throughout the day
 Consume milk with meals
 Chocolate milk may be better tolerated than plain
 Aged cheeses well tolerated especially hard cheese,
which contains very small quantities of lactose and is
usually very rich in calcium (e.g. parmesan, cheddar).
 Yogurts with live bacterial cultures that aid in lactose
digestion
 Addition of lactase preparation to milk or use of
enzyme tablet before consumption
 patients can also try lactose-free milk ”soy milk”
Conditions Affecting the Small
Intestine
Celiac Disease
Celiac Disease :
A condition characterized by an
abnormal immune reaction to wheat
gluten that causes severe intestinal
damage and nutrient malabsorption
Consequences of celiac disease
• The immune reaction to gluten causes
severe damage to the small intestine.
mucosa.
• Absorptive surface appears flattened due to
shortening or absence of villi
• Results in malabsorption of macronutrients,
fat-soluble vitamins, electrolytes, calcium,
magnesium, zinc, iron, folate, and vitamin
B12
 Develop anemia and low bone density
Symptoms of celiac disease
•
•
•
•
Diarrhea
Steatorrhea
Flatulence
Lactase deficiency may result from
mucosal damage
• children often have stunted growth,
underweight
• Severe rash
• Individuals with celiac disease who
do not eliminate gluten from the diet
are at increased risk of lymphotic
and intestinal cancer.
Medical nutrition therapy of celiac
disease
• Lifelong adherence to a gluten-free diet
• Avoid lactose-containing foods if lactase
deficiency is found.
• Eliminate wheat, rye, barley
• Read labels carefully – replace bread,
pasta, cereal
• Can be social liability
• Diet counseling
Inflammatory Bowel Disease
Inflammatory Bowel Disease
• Conditions having patterns of inflammation
• Complex set of genetic and environmental
factors( bacteria – irritant- viral) contribute
to the development but the exact cause is
unknown.
• Occurs most frequently in persons 15-25
years of age
1- Ulcerative Colitis
• An inflammatory bowel disease that involves
the colon. Inflammation affects the mucosa and
submucosa of the intestinal wall.
• Involves rectum and extends into the colon
• Symptoms:
 Diarrhea
 Rectal bleeding
 Abdominal pain
Normal Colon
Ulcerative Colitis
Complications – Ulcerative Colitis:
• Weight loss ,fever, weakness are
common when most of the colon is
involved
• A decrease in the oral intake of
nutrients is a common symptom and is
often due to abdominal pain fever
• Mucosal inflammation and its associated
diarrhea or bleeding lead to a loss of
protein, blood, minerals, electrolytes and
trace elements.
• severe disease is often associated with
anemia, dehydration, fluid & electrolyte
imbalances
• High risk of developing colon cancer –
colectomy may be performed (20-25%)
Medical therapy for ulcerative colitis:
• Drug therapy
Antidiarrheal agents
Immunosuppressants
Anti-inflammatory agents
• Surgical interventions
Nutrition therapy for ulcerative colitis:
The primary goal are to:
• Replace fluid and electrolyte losses
• Correction of deficiencies due to protein
and blood losses
• Low-fiber diet may reduce irritation by
minimizing fecal volume
• Bowel rest if colon function severely
impaired : food and fluids may be
withheld and fluids and electrolytes
supplied intravenously until colon
function is restored.
Conditions Affecting the Large
Intestine
Diverticular Disease of the colon
• Development of pebble-sized
herniations in the intestinal wall known
as diverticula.
• Most often occurs in sigmoid colon
• Prevalence increases with age
Diverticular
Disease
Diverticular Disease
of the Colon
• Development is influenced by the amount of
dietary fiber a person consumes
• Increasing the stool bulk by high fiber intake
may reduce the workload of the intestine
muscle that moves the wastes through the
colon.
• Low-fiber diet increases the pressure in the
intestine, causing small areas of the intestinal
wall to balloon outward over time.
Diverticulitis
Diverticulitis :
Localized inflammation or infection develops
in the area around a diverticulum
• It is the most common complication of
diverticulum
• Thought to result from hardened fecal matter
that abrades the mucosal lining
 Causes inflammation
 May cause microperforation – infection –
fistulas – peritonitis
Symptoms of Diverticulitis
• Persistent abdominal pain
• Fever
• Constipation
• Bleeding
• Nausea & vomiting
Nutrition therapy for
diverticular disease
• Gradual increase in dietary fiber –
insoluble fibers
• Avoid nuts, popcorn, and foods that
contain seeds
to prevent disease
progression
• In mild cases clear liquid diet may be
advised initially
that is gradually
progressed to low-fiber, low-residue
diet until inflammation and bleeding
subside
• For severe cases bowel rest is
necessary
( IV). Oral intake are
gradually
started
as
condition
improves.
Medical treatment for diverticular
disease
• Pain relief medication
• Antibiotics
• Surgical
interventions
may
be
needed for affected portion of colon
(colectomy